Town of Winthrop : Record of Deaths 1961, Part 43

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 43


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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(Official Designation) (Date of Issue of Permit)


X


ving ( DEATH enter an one r each () and (c)


not mean of dying. It failure. e. It means mg or compli- caused


wij amy, m' rise to & se (a). 1. under- ase last.


sas contrib- th but mot De terminal ation given


0.1


Chapter 137, 14. requires a to print or h cause or c, death on ericates, and 3. Acts of egres Fhysi- o Int or type nd signaturc.


IRAN Labigil 127 196 -9145


PLACE OF DEATH


MR.301A 1 DORCHESTER DASS (City or Town)> CARNEy-Hospital


'RITIONS R CERTIFICATE (a) Residence. No. ( l'sual place of abode)


Length of stay: In place of death. years. months. .days.' In place of residence. . years.


12 hrs


St.


(Give maiden name of wife inefull)


1. 1 .. AL CETWIEN 01 SET AND DEATH


PARENTS


(PRINT OR TYPE SIGNATURE)


A TRUE COPY ATTEST: Charles it macke City Registrar


X PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


Che Commonwealth of Passarhusrtis JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent. A. 09217


Registered No.


f(If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME


HARRIET


CLARSON


(First Name)


( Middle Name)


( Last Name)


( If deceased is a married, widowed or divorced woman, give also maiden name.)


42 Atlantic St.


St.


Winthrop, Mas3.


Length of stay: In place of death ..


.years .. ...


.. months.


5 days. In place of residence 30


years ............ months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


or Ditaowed


4I HEREBY


CERTIFY,


That We attended deceased from


Sept 26,


19 ...


19


61


01


to ...


Oct 1.


19.Q .... , death is said to


have occurred on the date stated above, at .


3:00 ....... m.


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


George J. Clarson


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Septicemia


Due To


(h)


Malignant lymphome-Hodgkin's


Due To


(c)


type


rterio sclorotio cardio


OTHER


SIGNIFICANT


vacoular .dicoase ..


20yrs


Was autopsy performed?


No


What test confirmed diagnosis?


clinical


5 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


M. D


Charles L. Clc. M. D.


(PRINT OR TYPE SIGNATURE)


(Address)


· Dir., Mass. Gen'l. Hosp. Date Oct I, 19 67


6


HolyCross.Cemetery ..... Malden,Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


October 4


19


61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. OMaley


ADDRESS


Winthrop Mass


Received and filed


OCT 4 1961


Charl & Mación


(Registrar)


PARENTS


17 NAME OF


FATHER


Johnston McDermott


18 BIRTHPLACE OF


FATHER (City)


Bo.s.t.on


(State or country)


Massachusetts


19 MAIDEN NAME


OF MOTHER


Mary E. Calhoun


20 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


Massachusetts


Sylvia McDermott


21


Informant


(Address)


42 Atlantic St., Winthrop Ma:


I HEREBY CERTIFY that a satisfactory standard certificate of death was/filed with me BEFORE the burial or transit permit was issued:


(Signature of Agent of Board of Health or other)


0%


10/2/10.


(Official Designation)


(Date of Issue of Permit)


1


TIONS


RTIFICATE


Ying CI DEATH enter lin one r each and (c)


mot meon of dying, rt failure, el It means tor compli- A caused


if any, rise to ase (a). under- last.


luis contrib- ich but mot terminal ciom given


hapter 137, 4. requires


1 al to print or h


cause or death on cricates, and r 3. Acts of og res Physi. int or type nd signature. . Dacton us only :X nk. 127 196 08145


5 mos


CONDITIONS


DETWEEN


ONCET AND


DEATH


11 IF STILLBORN, enter that fact here.


5 dys


AGE.


71 Years


Months


12


.Days


If under 24 hours


Hours.


Minutes


13 Usual


Housewife


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Own Home


15 Social Security No.


16 BIRTHPLACE (City) Eact. Boston


(State or country)


Massachusetts


[ ( Was deceased a U. S. War Veteran.


(if so specify WAR)


(a) Residence. No.


( l'sual place of abode)


( If nonresident, give rity or town and State)


No.


Massachusetts General Hospital CARER MEMORIAL


OD: TOWN


R-301A


3 DATE OF


DEATH


Oct. 1. 1961


(Month)


(Day)


(Year)


Wf last saw h .. G.Alive on


Oct


1


A TRUE COPY ATTEST: Charles H. Mackie City Registrar


AR-301A at Washington Ave


R TIONS 2 ERTIFICATE


L'ing Of DEATH genter lin one r each 6 and (c)


os mat mean of dying, rt failure, Il meons for compli- uh caused


if any, rise la die (a). under- de last.


iAs contrib- deh but not terminal orion given C. 3


hapter 137, 14. requires ag to print or the cause or o death on etucates, and T


. Acts of egres Physi- o Int or type nd signature.


Doctor us only CKink. 127 196


0-145


X 1 PLACE OF DEATH


SUFFOLK


(County)


DOSTON


(City or Town)


JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


4.20 To be filed for burial permit with Board of Health or its Agent.


Registered No.


f(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) PHYSICIAN - IMPORTANT No f ( Was deceased a U. S. War Veteran. {if so specify WAR)


(If deceased is a married, widowed or divorced woman, give also maiden name.) 34 Pleasant Street


St


Winthrop, Massachusetts


(If nonresident, give city or town and State)


Length of stay. In place of death ....... .... years


months.


10 days. In place of residence


5.0


years ...


... months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


October


3


1961


(Month)


(Day)


(Year)


4


Sept 2


CERTIF


That theattended deceased


19


to ...


19


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


$12


AGE.6.


Years.


Months.


.... Days


If under 24 hours


....


.Hours .........


Minutes


313 Usual


Occupation :


Clerk


(Kind of work done during most of working life)


14 Industry


or Business :


Stock broker


15 Social Security No.


010-07- 1265


16 BIRTHPLACE (City)


(State or country)


Nova Scotia


17 NAME OF


FATHER


Dougal Mackinnon


S Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


M. D


Chorlos . L .. Cl ="1, ..! ',D ...


(PRINT OR TYPE SIGNATURE)


(Address) Ass's Dir., Muss Goa'L Hasa. Date Oct 3 19 6]


6


Place of Burial or Cremation


Winthrop .... Cemetery. Winthrop (City or Town)


DATE OF BURIAL


October 6, 19


61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS Winthrop, Mass


Received and filed


Charles & Mac


(Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Nova Scotia


19 MAIDEN NAME


OF MOTHER


Margaret MacEachern


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Nova Scotia


21


Informant


Arthur J. O'Maley


(Address) 79 Atlantic St Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial, or transit permit was issued: Mcllamada


Signature of Agent of Board of Health or other)


3927


10/5/61


(Official Designation) (Date of Issue of Permit)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


of DIVORCEDSingle


W'elast saw


h.e.Lalive on


October 3


19 01, death is said to


have occurred on the date stated above, at


1:4.0.pn.


I. IL ... AL DETWEEN ORSET AND


DEATHS 3 dai


Due To


(b) Perforated Carcinoma of


Colon


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


Metastatic Cancernoma


of :


.y.e.s.


Was autopsy performed?


What test confirmed diagnosis?


...... autopsy


0 day


No. MASSACHUSETTS GENERAL HOSPITAL


Margaret


2 FULL NAME


1


Isabelle .... Mckinnon


(First Name)


(Middle Name)


( Last Name)


(a) Residence. No.


( L'sual place of abode)


61'


october


m


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Pronchopneumonia


(a)


A TRUE COPY ATTEST: Charles it. Mackie City Registrar


148


MR-301A -


TICTIONS IR CERTIFICATE


nlving · F DEATH a enter e jan one eor each . ) and (c)


dr not mean of dying, art failure. c. It means 1 or compli- Dich caused


us, if any, ve rise to use (a), ke under- use last.


dions contrib- ath but not the terminal "elition given


: Chapter 137, £954. requires lis to print or t: cause or f death on e tificates, and 148. Acts of nuires Physi- tprint or type 11 er signature.


-


1,1961


28145


PLACE OF DEATH


Worcester (County)


Worcester


(CWAdester Nursing 116 Houghton St. No.


Ho


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


221


To be filed for burial permit with Board of Health or its Agent. 2516


Registered No.


[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)


2 FULL NAME


ANNA


( Hutchinson)


MAW


[(Was deceased a


( First Name)


(Middle Name)


(Last Name)


(if so specify WAR)


(If deceased is a married. widowed or divorced woman, give also maiden name.)


73 Chester St.


Ave.


St.


Winthrop, Mass.


(Usual place of abode)


Length of stay: In place of death.


years


months.


days. In place of residence


years ...


.. months.


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWEDWidowed


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


John Maw


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


77


AGE


Years ...


Months ..........


Days


If under 24 hours


......


.. Hours .............. Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


023-12-0767


16 BIRTHPLACE (City)


(State or country)


East.Boston, .... Mass.


17 NAME OF


FATHER


Jonathan Hutchinson


18 BIRTHPLACE OF


England


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Ann Davis


20 BIRTHPLACE OF


England


.........


21 Informant Hr. John Naw 79 Walnut St. Saugus, Hass.


I HEREBY CERTIFY that a Satisfactory standard certificate of death pos ted with me BEFORE the buriat or transit perret was issued:


(Signature of Agent of Board of Health or other)


ACTING CO-COMMISSIONER


Oct 30,1961


(Official Designation)


(Date of Issue of Permit)


Charles M. Callehan ( 9.4)


1


PARENTS


6 Winthrop Cemetery Winthrop. Mal . MOTHER (City) (State or country)


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


No.v ....... 1, ..... 1961


19


7 NAME OF


FUNERAL


DIRECTOR Albert B. March 174 Winthrop St.


ADDRESS


winthrop


Received and filed NOV 1 1981 19


Robert J. O' Keefe


( Registrar)


61


(Month)


(Day)


(Year)


attended deceased from


That


Oct29


4 LHEREBY CERTIFY


Sept 17, 1961, to.


19.61


I last saw h&Calive on


Oct 27


1961, death is said to


have occurred on the date stated above, at


7 h& m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Carcinoma OF Stomach


INTERVAL


BETWEEN


ONSET AND


DEATH


1yr


Due To


(b)


Carcinoma of liver secondary 4 mois


Due To


toa.


(c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


NO


What test confirmed diagnosis?


Clinical Findings


5 Was disease or injury in any way related to occupation of deceased? \0 If so, specify


(Signed)


Joseph P. Hurley


Joseph P HURLEY


M. D


(PRINT OR TYPE SIGNATURE)


(Address) 590 MAIMI ST Date 10 29 1961


Y


PHYSICIAN - IMPORTANT


U. S. War Veteran.


(a) Residence. No.


(1f nonresident, give city or town and State)


50


3 DATE OF


DEATH


Oct.


29


1


6


NOV 1 41961 PM


1


City Clock


×


PLACE OF DEATH


Suffolk


(County)


Winthrop (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Registered No.


[(If death occurred in a hospital or institution,


St. ¿ give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME


Israel


Shuman


(First Name) (Middle Name) (Last Name)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


54 Lewis Ave.


(Usual place of abode)


St


Winthrop .... Mass ...


Length of stay: In place of death ..


.. years .. ........ months.


6 .. days.


SE


In place of residence.


.years


months ...


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


White


10^SINGLE (write the word)


MARRIED


WIDOWED Married


or DIVORCED


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


Posky


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ...


74 Years.


Months ......


Days


If under 24 hours .. Hours ........... Minutes


13 Usual


Occupation :


Allvigner


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


Other Ahuman


18 BIRTHPLACE OF FATHER (City) (State or country)


Russia


19 MAIDEN NAME


OF MOTHER


C. B.L.


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


21 Informant Gestude Ahuman


(Address) 54 Jewishve Wenthun


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: <


(Signature of Agent of Board of Health or other)


11/7/61


(Official Designation)


(Date of Issue of Permity


28145


U R-301A 1


ST JCTIONS OR ALCERTIFICATE In iving


EF DEATH it enter rehan one «for each ), ›) and (c)


as not mean oc of dying, Heart failure, 1, c. It means ca: or compli- iich caused


itis, if any, ve rise to muse (a), he under- use last.


nd ons contrib- o ath but not tothe terminal Codition given C


e: Chapter 137, of 954. requires ici is to print or t: cause or f death on c tificates, and tel 48, Acts of nuires Physi- toprint or type wu er signature.


(Diferit Dowa() Brudt Annett 10


Place of Burial or Cremation (City or Town)


DATE OF BURIAL 2200


19


7 NAME OF


FUNERAL DIRECTOR


JoyFuneral bruel.x


ADDRESS Chelsea


Received and filed


NOV 3 1961


.19


(Registrar)


2,


1961


(Month)


(Day)


(Year)


4 I


HEREBY CERTIFY


Oct


19 56, to NOVEMBER 2, 1961


I last saw h .. f.Lalive on


Novi


2,, 1961, death is said to


have occurred on the date stated above, at


101,00 P.m.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Nephritis, Chronic


2yrs,


Due To


(b)


Arteriosclerosis


2yrs


Due To (c)


OTHER


UREMIA


1yr


SIGNIFICANT


CONDITIONS Arterio sclerotic Heart Disease 1yV


Was autopsy performed?


NO


What test confirmed diagnosis?


Clinical


5 Was disease or injury in any way related to occupation of deceased? A If so, specify


(Signed) Please Liber Man, M. D CHARLES LIBERMAN, MID (PRINT OR TYPE SIGNATURE)


(Address) WINTHROP, MAS Date 11/2/1961


PARENTS


[(Was deceased a {U. S. War Veteran,


(if so specify WAR)


(If nonresident, give city or town and State)


3 DATE OF


DEATH


Thạt I attended deceased from


No. WinthropCommunity .... Hospital


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE. RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


PLACE OF DEATH


Suffolk (County


PETI


Winthrop. (City of Town)


No.


14 Edgehill Road


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Registered No.


[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME


Frances.L ..... Coughlin


(First Name)


(Middle Name)


(Last Name)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


14 Edgehill Road


St


(If nonresident, give city or town and State)


Length of stay: In place of death.


years.


months ..


days. In place of residence 6.0


.. years,


months ...


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


(write the word)


WIDOWED


or DIVOREPried


Female


White


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


John J. Coughlin


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.7.6


Years.


Months ...


,Days


If under 24 hours


Hours ....


Minutes


13 Usual


Housewife


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Own .... Home


15 Social Security No.


16 BIRTHPLACE (City)


EastBoston


(State or country)


Massachuset


17 NAME OF


FATHER


Thomas Sheffield


18 BIRTHPLACE OF


FATHER (City)


East Boston.


(State or country)


Massachusetts


19 MAIDEN NAME


OF MOTHER


Catherine M. Lang


20 BIRTHPLACE OF


MOTHER (City)


East Boston


(State or country)


Massachusetts


21


Informant


John J. Coughlin


(Address)


14 Edgehill Road, Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


(Signature of Agent of Board of Health or. other) 1


11/6/61


(Official Designation)


(Date of Issue of Permit)


STUCTIONS OR AICERTIFICATE


Irgiving


E)F DEATH


t enter re han one Is for each ), b) and (c)


cis not mean ot of dying, s eart failure, a, tc. It means ca. or compli- tich caused


iti:s, if any, h ve rise to e zuse (a), g he under- tuse last.


na'ons contrib- o ath but not tithe terminal Codition given


e Chapter 137, of 954. requires iciis to print or cause or :8 f death on ctificates, and ter 48, Acts of r uires Physi- trint or type Wer signature.


6


Winthrop Cemetery


Winthrop.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


November .....?..


19.61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS Winthrop. Mass


Received and filed


November 6,


1961


(Registrar)


PARENTS


Was autopsy performed?


What test confirmed diagnosis? post-mortem judgement


5 Was disease or injury in any way related to occupation of deceased? no If so, specify


(Signed)


ed) arthur @ manay, M. D


Arthur C. Murray


(PRINT OR TYPE SIGNATURE)


(Winthrop Board of Health 11-3-61


-


Due To


(c)


Occlusion


sudden


OTHER


SIGNIFICANT


CONDITIONS


nonse


-


INTERVAL


BETWEEN


ONSET AND


DEATH


(a)


November 3 1961.


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


19


19


I last saw h ........ alive on


19 ..........


., death is said to


have occurred on the date stated above, at


11


P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Natural Causes


Due To


Presumably Coronary


(b)


no


₹ R-301A 1


-6(128145


[(Was deceased a


U. S. War Veteran,


[if so specify WAR)


(Usual place of abode)


3 DATE OF


DEATH


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


1


6


NOV - 61961 PM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


R-301A 1


CTIONS IR ERTIFICATE


ving F DEATH enter lan one or each ) and (c)


not mean of dying, art failure, . It means or compli- ch caused


, if any, gle rise to use (a), e under- use last.


fins contrib- ath but not o se terminal o. ition given


lapter 137, 1!1. requires into print or le cause or 0 death on r cates, and , Acts of gires Physi- Int or type disignature.


-62-925686


X PLACE OF DEATH


Suffolk


(County)


Winthrop


(City or Town)


Winthrop Community Hospital No.


Thr Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


001


[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


[(Was deceased a


{U. S. War Veteran,


no


[ if so specify WAR)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


302 Maverick St.


East Boston, Mass.


St.


(If nonresident, give city or town and State)


Length of stay: In place of death ..


... years ...


. months


31.days. In place of residence.


.. years


months


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


November


4


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY


That I attended deceased from


OCT 5


to ...


Nev 4


19.6.1


I last saw h .. . Malive on


Nov- 4, 1961, death is said to


have occurred on the date stated above, at 2 :15 Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


CORONARY THROMBOSIS


(a)


· HYPERTENSIVE HEART DISEASE (b)


Due To (c)


OTHER


DIVERTICULITIS I PERFORATION, MO


SIGNIFICANT


AND HEMORRHAGE


CONDITIONS /INTESTINALOBSTRUCTION ZUKS


Was autopsy performed?


NO


What test confirmed diagnosis ?


CLINICA LOSURGICAL


:


5 Was disease or injury inany way related to occupation of deceased? NO If so, specify


(Signed)


Charles Jaleman


M. D.


369 HANOVER ST (PRINT OR TYPE SIGNATURE)


BOSTON


(Address)


Date .......


11/4 .19 61


6 Holy Cross Cemetery Malden


Place of Burial or Cremation


DATE OF BURIAL


Nov. 7,


(City or Town) 19.61


7 NAME OF


FUNERAL DIRECTOR


Vincent Rapino


ADDRESS 9 Chelsea St., East Boston, Mass.


Received and filed November 6, 1961


(Registrar)


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


married


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divorced Giovannina DeVita


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE86


Years ............


Months.


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Retired


14 Industry


or Business :


15 Social Security No.


011-01-3611


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Ferdinando Marasca


18 BIRTHPLACE OF


FATHER (City)


(State or country)




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